Team-Based Care Enhances Outcomes for Pregnant Women with Substance Use Disorders

A recent study conducted by Oregon Health & Science University highlights the effectiveness of a team-based, comprehensive approach in caring for pregnant women struggling with substance use disorders. This model emphasizes integrating medical treatment, behavioral health support, and social services to address the complex needs of these patients, ultimately aiming to improve health outcomes and foster family stability.

The research draws from an in-depth analysis of seven organizations participating in Project Nurture and its rural expansion, Nurture Oregon. These programs are designed to provide stigma-free, coordinated care by bringing together a diverse team of healthcare professionals, including family physicians, nurse midwives, social workers, addiction counselors, peer supporters, and doulas. Such multidisciplinary collaboration helps ensure that all aspects of a patient's health and social needs are addressed.

Findings, published in The Annals of Family Medicine, show that this holistic care paradigm can significantly impact both maternal and infant health. In 2020, reports indicated that between 8% and 11% of pregnant women used illicit substances, though actual figures might be higher due to underreporting. Substance use during pregnancy poses serious risks, such as preterm birth, longer hospital stays, and increased child welfare interventions. Unfortunately, only a small fraction of affected pregnant women receive necessary treatment — often hindered by costs, stigma, and limited access, especially in rural areas.

Deborah Cohen, Ph.D., leading the study and a family medicine professor at OHSU, shared a poignant encounter with a patient that exemplifies the model’s potential. Sitting alongside a woman recovering from substance use, reconnecting with her family, and planning her future, Cohen reflected on how this approach transforms lives not only for the mother but also for the child.

However, expanding this care model faces challenges, particularly in rural settings. Key functions of effective teams include outreach, care coordination, advocacy, and resource linkage—many of which are often unseen or unpaid. Some behavioral health organizations struggle to establish full medical partnerships, relying on peers and doulas to bridge gaps, which, while innovative, does not replace integrated medical care.

The study emphasizes the importance of involving full-scope primary care providers like family physicians who can deliver comprehensive medical services. Regardless of the team structure, all organizations provided crucial services such as care coordination, emotional support, and social assistance, which positively influenced patient well-being.

Policy-wise, the research underscores systemic issues in sustaining integrated care under current payment models. Cohen advocates for long-term investments and systemic reforms to support the vital, often unpaid, work of care teams, emphasizing that the community benefits far outweigh the costs. She envisions this interdisciplinary approach guiding primary care beyond perinatal substance use, promoting a more holistic, compassionate, and effective healthcare system.

This study offers concrete insights into how care teams can better support vulnerable populations, illustrating a model that prioritizes collaboration, flexibility, and patient-centered support, with implications for healthcare policy and practice alike.